Prognostic value of the acute DMSA scan in children with first urinary tract infection.

We attempted to verify in a group of 101 children with first urinary tract infection whether it was possible to identify groups of patients with different risks of developing renal scarring by taking into account both the extent of kidney involvement documented in the acute phase of infection using a dimercaptosuccinic acid (DMSA) scan, and the presence or absence of vesicoureteral reflux (VUR). The frequency of persistent lesions in kidneys with mild-moderate lesions (less than 50% of kidney involvement) in the presence of VUR or in non-refluxing kidneys was similar (P=0.1447), while the frequency of persistent lesions in kidneys with severe lesions in the presence of VUR was significantly higher than the frequency of persistent lesions in non-refluxing kidneys (P=0.0089). The extent of kidney involvement and the presence of VUR make possible the identification of different categories of risk of scarring: in the "low risk group" (normal kidney with/without VUR) the risk of scarring is 0%; in the "intermediate risk group" (mild lesions with/without VUR; extensive lesions without VUR) the risk of scarring is between 14% and 38%, while in the "high risk group" (extensive lesions with VUR) the risk of scarring is 88%. Quantifying the risk of scarring could help in planning the treatment or in modifying the later strategy.

Acute renal cortical scintigraphy in children with a first urinary tract infection.

This prospective study, performed in 101 children with a first symptomatic urinary tract infection (UTI), evaluates the diagnostic value of clinical, biological, and ultrasound parameters in detecting children with acute renal infection documented by dimercaptosuccinic acid (DMSA) scintigraphy. In children with a positive DMSA scan, mean C-reactive protein (CRP) was higher than in children with a normal DMSA scan (114+/-64 vs. 67+/-38 mg/dl, mean+/-SD, P=0.0002). The sensitivity and specificity of CRP was 64% and 68%, respectively. In children with severe kidney involvement, mean CRP and white blood count (WBC) were higher than in children with mild/moderate disease (151+/-83 vs. 92+/-55 mg/dl for CRP, P=0.0149; 20,100+/-6,854 vs. 15,023+/-6,145 WBC/ mm3 for WBC, P=0.0131). The sensitivity and specificity was 85% and 20% for CRP, and 77% and 18% for WBC, respectively. One or more areas of abnormal cortical echogenicity were documented in 3% of kidneys with positive DMSA scans. Dilatation of the collecting system was observed in 24% of kidneys. The sensitivity and specificity of ultrasonography was 27% and 89%, respectively. In conclusion, clinical, biological, and ultrasound parameters do not accurately distinguish cystitis from pyelonephritis in children with UTI and do not identify children with severe renal damage. Accordingly, we recommend that DMSA scan should be added to the initial work-up of children with UTI.

[Blood coagulation parameters in insulin-dependent diabetic children at onset of the disease and after 3 months]. / Parametri emocoagulativi in bambini diabetici insulino-dipendenti all'esordio e dopo tre mesi di malattia.

Levels of factors II, V, VII, VIII C, VIII R:Ag, VIII vW, IX, X, PT, PTT, TT, TR, antithrombin III and fibrinogen were evaluated in 11 children with insulin-dependent diabetes mellitus (IDDM) at onset of disease and after 3 months and in 15 healthy age-matched controls. At onset of IDDM a significant increase was observed only in mean values of factor VIII C, VIII R:Ag and in VIII vW. After 3 months the levels of factor VIII C returned within the normal range whilst no variations of factor VIII R:Ag and vW were found. These data show that coagulation abnormalities are already present at onset of IDDM and that endothelial damage evidenced by high values of factor VIII R:Ag and vW may persist even in a phase of good metabolic control. Levels of factor VIII C seem to be related to the increased protein glycosylation of IDDM.